title: [Unusual diagnosis in recurrent arthritis, erythema nodosum and arrhythmia].
abstract: METHODS
  A 42-year-old woman, with recurrent arthritis of the large joints and erythema nodosum for 7 years, was admitted because of recent onset of bouts of rapid heart rate. A 2/6 systolic murmur at Erb's point was the only contributory finding on physical examination.
  
  
  METHODS
  The transaminases and gamma-GT were elevated, as were total cholesterol, LDL fraction, IgM, total protein, gamma-globulin and IgM. Antimitochondrial antibodies, especially anti-M2, were positive, while rheumatoid factor and C-reactive protein were negative. ANA, ANCA and antibodies against double-strand DNA were not demonstrated. ENA screening was negative. Abdominal computed tomography showed discrete intrahepatic cholestasis. Liver biopsy revealed chronic destructive cholangitis, i.e. the early stage of primary biliary cirrhosis.
  
  
  METHODS
  On treatment with ursodeoxycholic acid (10 mg/kg daily) the patient has remained free of symptoms for 3 years and laboratory tests no longer showed evidence of impaired liver function.
  
  
  CONCLUSIONS
  Primary biliary cirrhosis should be included in the differential diagnosis of recurrent arthritis and erythema nodosum, as early treatment with ursodeoxycholic acid can favourably influence its course.
authors.affiliation: Abteilung Nephrologie und Rheumatologie, Universität Göttingen.
authors.forename: R W
authors.initials: RW
authors.lastname: Grunewald
authors.forename: G M
authors.initials: GM
authors.lastname: Fiedler
authors.forename: F
authors.initials: F
authors.lastname: Stöckmann
authors.forename: A
authors.initials: A
authors.lastname: Schauer
authors.forename: G A
authors.initials: GA
authors.lastname: Müller
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D001168:Arthritis / Q000175:diagnosis*; D001706:Biopsy; D002761:Cholangitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D002908:Chronic Disease; D003937:Diagnosis, Differential; D004893:Erythema Nodosum / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000473:pathology; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D012008:Recurrence; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014580:Ursodeoxycholic Acid / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D014580:Ursodeoxycholic Acid
vernacular_title: Ungewöhnliche Diagnose bei rezidivierender Arthritis, Erythema nodosum und Herzrhythmusstörungen.